Risk factors for postoperative delirium after Stanford type A aortic dissection : A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Pu ¹ ,  WU Qiaomei ² , GUO Shichang ¹ , WANG Mingxin ¹ , CHEN Meiying ¹ , MU Nan ¹ , TAN Wenting ²

1. The Second Clinical Medical College of Guangzhou University of Traditional Chinese Medicine, Guangzhou, 510006, P. R. China;
2. The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, 510120, P. R. China;

Corresponding author：

WU Qiaomei, Email: wqm512@126.com

Keywords：

Stanford type A aortic dissection; postoperative delirium; risk factors; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202211001

Video：

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Objective To systematically evaluate the risk factors for postoperative delirium after surgery for Stanford type A aortic dissection. Methods We searched the CNKI, SinoMed, Wanfang data, VIP, PubMed, Web of Science, EMbase, The Cochrane Library database from inception to September 2022. Case-control studies, and cohort studies on risk factors for postoperative delirium after surgery for Stanford type A aortic dissection were collected to identify studies about the risk factors for postoperative delirium after surgery for Stanford type A aortic dissection. Quality of the included studies was evaluated by the Newcastle-Ottawa scale (NOS). The meta-analysis was performed by RevMan 5.3 software and Stata 15.0 software. Results A total of 21 studies were included involving 3385 patients. The NOS score was 7-8 points. The results of meta-analysis showed that age (MD=2.58, 95%CI 1.44 to 3.72, P＜0.000 01), male (OR=1.33, 95%CI 1.12 to 1.59, P=0.001), drinking history (OR=1.45, 95%CI 1.04 to 2.04, P=0.03), diabetes history (OR=1.44, 95%CI 1.12 to 1.85, P=0.005), preoperative leukocytes (MD=1.17, 95%CI 0.57 to 1.77), P=0.000 1), operation time (MD=21.82, 95%CI 5.84 to 37.80, P=0.007), deep hypothermic circulatory arrest (DHCA) time (MD=3.02, 95%CI 1.04 to 5.01, P=0.003), aortic occlusion time (MD=8.94, 95%CI 2.91 to 14.97, P=0.004), cardiopulmonary bypass time (MD=13.92, 95%CI 5.92 to 21.91, P=0.0006), ICU stay (MD=2.77, 95%CI 1.55 to 3.99, P＜0.000 01), hospital stay (MD=3.46, 95%CI 2.03 to 4.89, P＜0.0001), APACHEⅡ score (MD=2.76, 95%CI 1.59 to 3.93, P＜0.000 01), ventilation support time (MD=6.10, 95%CI 3.48 to 8.72, P＜0.000 01), hypoxemia (OR=2.32, 95%CI 1.40 to 3.82, P=0.001), the minimum postoperative oxygenation index (MD=−79.52, 95%CI −125.80 to −33.24, P=0.000 8), blood oxygen saturation (MD=−3.50, 95%CI −4.49 to −2.51, P＜0.000 01), postoperative hemoglobin (MD=−6.35, 95%CI −9.21 to −3.50, P＜0.000 1), postoperative blood lactate (MD=0.45, 95%CI 0.15 to 0.75, P=0.004), postoperative electrolyte abnormalities (OR=5.94, 95%CI 3.50 to 10.09, P＜0.000 01), acute kidney injury (OR=1.92, 95%CI 1.34 to 2.75, P=0.000 4) and postoperative body temperature (MD=0.79, 95%CI 0.69 to 0.88, P＜0.000 01) were associated with postoperative delirium after surgery for Stanford type A aortic dissection. Conclusion The current evidence shows that age, male, drinking history, diabetes history, operation time, DHCA time, aortic occlusion time, cardiopulmonary bypass time, ICU stay, hospital stay, APACHEⅡ score, ventilation support time, hypoxemia and postoperative body temperature are risk factors for the postoperative delirium after surgery for Stanford type A aortic dissection. Oxygenation index, oxygen saturation, and hemoglobin number are protective factors for delirium after Stanford type A aortic dissection.

Citation： WANG Pu, WU Qiaomei, GUO Shichang, WANG Mingxin, CHEN Meiying, MU Nan, TAN Wenting. Risk factors for postoperative delirium after Stanford type A aortic dissection : A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(5): 791-799. doi: 10.7507/1007-4848.202211001 Copy

1.	Elsayed RS, Cohen RG, Fleischman F, et al. Acute type A aortic dissection. Cardiol Clin, 2017, 35(3): 331-345.
2.	Gudbjartsson T, Ahlsson A, Geirsson A, et al. Acute type A aortic dissection—A review. Scand Cardiovasc J, 2020, 54(1): 1-13.
3.	Whitlock EL, Torres BA, Lin N, et al. Postoperative delirium in a substudy of cardiothoracic surgical patients in the BAG-RECALL clinical trial. Anesth Analg, 2014, 118(4): 809-817.
4.	Krzych LJ, Wybraniec MT, Krupka-Matuszczyk I, et al. Complex assessment of the incidence and risk factors of delirium in a large cohort of cardiac surgery patients: A single-center 6-year experience. Biomed Res Int, 2013, 2013: 835850.
5.	Rudolph JL, Marcantonio ER. Review articles: Postoperative delirium: Acute change with long-term implications. Anesth Analg, 2011, 112(5): 1202-1211.
6.	Chen H, Mo L, Hu H, et al. Risk factors of postoperative delirium after cardiac surgery: A meta-analysis. J Cardiothorac Surg, 2021, 16(1): 113.
7.	周楚芝, 杨建安, 温隽珉, 等. 急性A型主动脉夹层患者术后谵妄发生的危险因素分析. 中国动脉硬化杂志, 2016, 24(12): 1253-1257.
8.	王殊. Stanford A型主动脉夹层术后谵妄危险因素分析. 南京医科大学, 2018.
9.	王晨雷. Stanford A型主动脉夹层术后谵妄状态的临床特点和相关危险因素研究. 昆明医科大学, 2016.
10.	宋先荣, 程兆云, 刘富荣, 等. Stanford A型主动脉夹层术后谵妄的临床研究. 中华胸心血管外科杂志, 2016, 32(10): 607-611.
11.	陆地, 周晓东, 王珏, 等. Stanford A型主动脉夹层患者发生术后谵妄的危险因素研究. 浙江医学, 2022, 44(5): 480-483.
12.	李晓晴, 马闻建, 毕齐, 等. A型主动脉夹层术后谵妄的发生率和危险因素研究. 安徽医药, 2014, 18(6): 1065-1069.
13.	黄真锋, 法宪恩, 王宏山, 等. 急性主动脉夹层弓部手术后谵妄的临床研究. 东南大学学报(医学版), 2018, 37(2): 259-262.
14.	Shi Q, Mu X, Zhang C, et al. Risk factors for postoperative delirium in type A aortic dissection patients: A retrospective study. Med Sci Monit, 2019, 25: 3692-3699.
15.	Liu Z, Pang X, Zhang X, et al. Incidence and risk factors of delirium in patients after type-A aortic dissection surgery. J Cardiothorac Vasc Anesth, 2017, 31(6): 1996-1999.
16.	朱悦倩, 杨菁, 孙煦, 等. 急性Stanford A型夹层术后谵妄的危险因素分析. 实用医学杂志, 2020, 36(7): 940-943.
17.	孙芳, 施乾坤, 章淬, 等. 急性主动脉夹层术后谵妄状态的高危因素分析. 临床荟萃, 2014, 29(7): 721-724.
18.	牛永胜, 李莉, 魏海燕, 等. 急性A型主动脉夹层患者术后谵妄的危险因素. 临床麻醉学杂志, 2022, 38(6): 622-626.
19.	贺清, 薛超, 李步潆, 等. StanfordA型主动脉夹层动脉瘤患者杂交手术后谵妄特征及发生的危险因素分析. 陕西医学杂志, 2020, 49(11): 1432-1435.
20.	方妙弦, 熊卫萍, 曾嵘, 等. Stanford A型主动脉夹层患者术后谵妄的危险因素分析. 中国胸心血管外科临床杂志, 2016, 23(4): 357-361.
21.	成丽敏. 主动脉夹层术后谵妄的危险因素及预防. 国际护理学杂志, 2020, 39(10): 1862-1864.
22.	白耀邦, 李培军, 吴振华, 等. Stanford A型主动脉夹层患者术后谵妄的相关危险因素分析. 天津医药, 2018, 46(5): 471-474.
23.	Lv XC, Lin Y, Wu QS, et al. Plasma interleukin-6 is a potential predictive biomarker for postoperative delirium among acute type a aortic dissection patients treated with open surgical repair. J Cardiothorac Surg, 2021, 16(1): 146.
24.	Cai S, Zhang X, Pan W, et al. Prevalence, predictors, and early outcomes of post-operative delirium in patients with type A aortic dissection during intensive care unit stay. Front Med (Lausanne), 2020, 7: 572581.
25.	Lin YJ, Lin LY, Peng YC, et al. Association between glucose variability and postoperative delirium in acute aortic dissection patients: An observational study. J Cardiothorac Surg, 2021, 16(1): 82.
26.	闫晓英, 刘哲, 宋艳, 等. A型主动脉夹层术患者术后谵妄的影响因素分析. 护理实践与研究, 2020, 17(1): 7-10.
27.	李雪苹, 王磊, 张淮, 等. Stanford A型主动脉夹层患者术后谵妄风险预测评分模型的构建与效果验证. 中华护理杂志, 2022, 57(8): 950-957.
28.	David TE, Maganti M, Armstrong S. Aortic root aneurysm: Principles of repair and long-term follow-up. J Thorac Cardiovasc Surg, 2010, 140(6 Suppl): S14-S19.
29.	伍侨. 老年术后谵妄发生率及危险因素的系统评价. 成都中医药大学, 2021.
30.	李冰冰, 覃颖, 张艳. 老年髋部骨折病人术后谵妄早期识别的研究进展. 护理研究, 2020, 34(16): 2888-2891.
31.	He J, Ling Q, Chen Y. Construction and application of a model for predicting the risk of delirium in postoperative patients with type A aortic dissection. Front Surg, 2021, 8: 772675.
32.	李瑛, 李贤煌, 胡燕, 等. 心脏外科术后患者发生谵妄危险因素的Meta分析. 解放军护理杂志, 2022, 39(6): 72-76.
33.	Zhang G, Wang Z, Wang D, et al. A systematic review and meta-analysis of the correlation between operation time and postoperative delirium in total hip arthroplasty. Ann Palliat Med, 2021, 10(10): 10459-10466.
34.	Bucerius J, Gummert JF, Borger MA, et al. Predictors of delirium after cardiac surgery delirium: effect of beating-heart (off-pump) surgery. J Thorac Cardiovasc Surg, 2004, 127(1): 57-64.
35.	Stransky M, Schmidt C, Ganslmeier P, et al. Hypoactive delirium after cardiac surgery as an independent risk factor for prolonged mechanical ventilation. J Cardiothorac Vasc Anesth, 2011, 25(6): 968-974.
36.	Bakker RC, Osse RJ, Tulen JH, et al. Preoperative and operative predictors of delirium after cardiac surgery in elderly patients. Eur J Cardiothorac Surg, 2012, 41(3): 544-549.
37.	包萌萌, 魏昌伟, 吴安石. 术后谵妄预测及诊断的研究进展. 中华麻醉学杂志, 2020, 40(4): 504-508.
38.	van den Akker JP, Egal M, Groeneveld AB. Invasive mechanical ventilation as a risk factor for acute kidney injury in the critically ill: A systematic review and meta-analysis. Crit Care, 2013, 17(3): R98.
39.	王明欣, 周春姣, 嵇星辰, 等. 食管癌患者术后肺部感染危险因素的系统评价与Meta分析. 中国胸心血管外科临床杂志, 2023, 30(10): 1467-1474.

1. Elsayed RS, Cohen RG, Fleischman F, et al. Acute type A aortic dissection. Cardiol Clin, 2017, 35(3): 331-345.
2. Gudbjartsson T, Ahlsson A, Geirsson A, et al. Acute type A aortic dissection—A review. Scand Cardiovasc J, 2020, 54(1): 1-13.
3. Whitlock EL, Torres BA, Lin N, et al. Postoperative delirium in a substudy of cardiothoracic surgical patients in the BAG-RECALL clinical trial. Anesth Analg, 2014, 118(4): 809-817.
4. Krzych LJ, Wybraniec MT, Krupka-Matuszczyk I, et al. Complex assessment of the incidence and risk factors of delirium in a large cohort of cardiac surgery patients: A single-center 6-year experience. Biomed Res Int, 2013, 2013: 835850.
5. Rudolph JL, Marcantonio ER. Review articles: Postoperative delirium: Acute change with long-term implications. Anesth Analg, 2011, 112(5): 1202-1211.
6. Chen H, Mo L, Hu H, et al. Risk factors of postoperative delirium after cardiac surgery: A meta-analysis. J Cardiothorac Surg, 2021, 16(1): 113.
7. 周楚芝, 杨建安, 温隽珉, 等. 急性A型主动脉夹层患者术后谵妄发生的危险因素分析. 中国动脉硬化杂志, 2016, 24(12): 1253-1257.
8. 王殊. Stanford A型主动脉夹层术后谵妄危险因素分析. 南京医科大学, 2018.
9. 王晨雷. Stanford A型主动脉夹层术后谵妄状态的临床特点和相关危险因素研究. 昆明医科大学, 2016.
10. 宋先荣, 程兆云, 刘富荣, 等. Stanford A型主动脉夹层术后谵妄的临床研究. 中华胸心血管外科杂志, 2016, 32(10): 607-611.
11. 陆地, 周晓东, 王珏, 等. Stanford A型主动脉夹层患者发生术后谵妄的危险因素研究. 浙江医学, 2022, 44(5): 480-483.
12. 李晓晴, 马闻建, 毕齐, 等. A型主动脉夹层术后谵妄的发生率和危险因素研究. 安徽医药, 2014, 18(6): 1065-1069.
13. 黄真锋, 法宪恩, 王宏山, 等. 急性主动脉夹层弓部手术后谵妄的临床研究. 东南大学学报(医学版), 2018, 37(2): 259-262.
14. Shi Q, Mu X, Zhang C, et al. Risk factors for postoperative delirium in type A aortic dissection patients: A retrospective study. Med Sci Monit, 2019, 25: 3692-3699.
15. Liu Z, Pang X, Zhang X, et al. Incidence and risk factors of delirium in patients after type-A aortic dissection surgery. J Cardiothorac Vasc Anesth, 2017, 31(6): 1996-1999.
16. 朱悦倩, 杨菁, 孙煦, 等. 急性Stanford A型夹层术后谵妄的危险因素分析. 实用医学杂志, 2020, 36(7): 940-943.
17. 孙芳, 施乾坤, 章淬, 等. 急性主动脉夹层术后谵妄状态的高危因素分析. 临床荟萃, 2014, 29(7): 721-724.
18. 牛永胜, 李莉, 魏海燕, 等. 急性A型主动脉夹层患者术后谵妄的危险因素. 临床麻醉学杂志, 2022, 38(6): 622-626.
19. 贺清, 薛超, 李步潆, 等. StanfordA型主动脉夹层动脉瘤患者杂交手术后谵妄特征及发生的危险因素分析. 陕西医学杂志, 2020, 49(11): 1432-1435.
20. 方妙弦, 熊卫萍, 曾嵘, 等. Stanford A型主动脉夹层患者术后谵妄的危险因素分析. 中国胸心血管外科临床杂志, 2016, 23(4): 357-361.
21. 成丽敏. 主动脉夹层术后谵妄的危险因素及预防. 国际护理学杂志, 2020, 39(10): 1862-1864.
22. 白耀邦, 李培军, 吴振华, 等. Stanford A型主动脉夹层患者术后谵妄的相关危险因素分析. 天津医药, 2018, 46(5): 471-474.
23. Lv XC, Lin Y, Wu QS, et al. Plasma interleukin-6 is a potential predictive biomarker for postoperative delirium among acute type a aortic dissection patients treated with open surgical repair. J Cardiothorac Surg, 2021, 16(1): 146.
24. Cai S, Zhang X, Pan W, et al. Prevalence, predictors, and early outcomes of post-operative delirium in patients with type A aortic dissection during intensive care unit stay. Front Med (Lausanne), 2020, 7: 572581.
25. Lin YJ, Lin LY, Peng YC, et al. Association between glucose variability and postoperative delirium in acute aortic dissection patients: An observational study. J Cardiothorac Surg, 2021, 16(1): 82.
26. 闫晓英, 刘哲, 宋艳, 等. A型主动脉夹层术患者术后谵妄的影响因素分析. 护理实践与研究, 2020, 17(1): 7-10.
27. 李雪苹, 王磊, 张淮, 等. Stanford A型主动脉夹层患者术后谵妄风险预测评分模型的构建与效果验证. 中华护理杂志, 2022, 57(8): 950-957.
28. David TE, Maganti M, Armstrong S. Aortic root aneurysm: Principles of repair and long-term follow-up. J Thorac Cardiovasc Surg, 2010, 140(6 Suppl): S14-S19.
29. 伍侨. 老年术后谵妄发生率及危险因素的系统评价. 成都中医药大学, 2021.
30. 李冰冰, 覃颖, 张艳. 老年髋部骨折病人术后谵妄早期识别的研究进展. 护理研究, 2020, 34(16): 2888-2891.
31. He J, Ling Q, Chen Y. Construction and application of a model for predicting the risk of delirium in postoperative patients with type A aortic dissection. Front Surg, 2021, 8: 772675.
32. 李瑛, 李贤煌, 胡燕, 等. 心脏外科术后患者发生谵妄危险因素的Meta分析. 解放军护理杂志, 2022, 39(6): 72-76.
33. Zhang G, Wang Z, Wang D, et al. A systematic review and meta-analysis of the correlation between operation time and postoperative delirium in total hip arthroplasty. Ann Palliat Med, 2021, 10(10): 10459-10466.
34. Bucerius J, Gummert JF, Borger MA, et al. Predictors of delirium after cardiac surgery delirium: effect of beating-heart (off-pump) surgery. J Thorac Cardiovasc Surg, 2004, 127(1): 57-64.
35. Stransky M, Schmidt C, Ganslmeier P, et al. Hypoactive delirium after cardiac surgery as an independent risk factor for prolonged mechanical ventilation. J Cardiothorac Vasc Anesth, 2011, 25(6): 968-974.
36. Bakker RC, Osse RJ, Tulen JH, et al. Preoperative and operative predictors of delirium after cardiac surgery in elderly patients. Eur J Cardiothorac Surg, 2012, 41(3): 544-549.
37. 包萌萌, 魏昌伟, 吴安石. 术后谵妄预测及诊断的研究进展. 中华麻醉学杂志, 2020, 40(4): 504-508.
38. van den Akker JP, Egal M, Groeneveld AB. Invasive mechanical ventilation as a risk factor for acute kidney injury in the critically ill: A systematic review and meta-analysis. Crit Care, 2013, 17(3): R98.
39. 王明欣, 周春姣, 嵇星辰, 等. 食管癌患者术后肺部感染危险因素的系统评价与Meta分析. 中国胸心血管外科临床杂志, 2023, 30(10): 1467-1474.

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Risk factors for postoperative delirium after Stanford type A aortic dissection : A systematic review and meta-analysis

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